Prostate Cancer - Questions and Answers

Prostate cancer is the most common malignancy diagnosed in men in the United States.
The best screening method is a combination of digital rectal exam and serum prostate-specific antigen.
Clinically localized prostate cancer is treated with surgery, radiation, cryotherapy, or watchful waiting.


1. How common is prostate cancer?
It is the most common malignancy diagnosed in men in the United States; almost 200,000 new cases were diagnosed in 2001.

2. Do most men die with prostate cancer, rather than from it?
Yes, but approximately 31,500 men died of prostate cancer in 2001 in the United States. Thus, it should not be treated as benign.

3. What are the early symptoms of prostate cancer?
There are none. By the time significant symptoms develop, the disease is likely to be advanced. This is an argument for screening to detect prostate cancer.

4. What is the best screening method for prostate cancer?
Digital rectal examination (DRE) combined with serum prostate-specific antigen (PSA). Since PSA testing was introduced, there has been a stage migration with less metastatic disease and more local-regional disease being detected.

5. How is prostate cancer diagnosed?
It is diagnosed with prostate biopsy, which is a biopsy using transrectal ultrasound for guidance. Many cancers are discovered incidentally at transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH).

6. When is prostate biopsy indicated?
When either the PSA or DRE result is abnormal.

7. Does an elevated PSA level mean a man has prostate cancer?
No. PSA can be elevated with BPH, prostatitis, or after prostate trauma. It is prostate specific, not prostate cancer specific.

8. What is a free PSA?
Free PSA is the percentage of PSA that is not bound to a serum protein carrier. The ratio of free to total PSA is helpful in determining when to do a prostate biopsy. "Free" is good because a higher ratio of free to total PSA is less likely to represent a prostate cancer.

9. Are there any known risk factors for prostate cancer?
Yes. African-American men and men with a family history of prostate cancer are at an increased risk. A high-fat diet may play a role in increasing risk of many cancers, including prostate cancer.

10. What is Gleason's sum?
It's a score that the pathologist gives prostate cancer to estimate its aggressiveness. The two predominant patterns of cancer are scored 1 to 5, and the sum is, therefore, between 2 and 10. Tumors can be well differentiated (2, 3, 4), moderately differentiated (5, 6, 7), or poorly differentiated (8, 9, 10).

11. How is clinically localized prostate cancer treated?
Surgery (radical prostatectomy), radiation therapy by external beam or interstitial seed implant, cryotherapy, or watchful waiting.

12. How is advanced metastatic prostate cancer treated?
Hormonal ablation therapy (orchiectomy or luteinizing hormone-releasing hormone agonist drugs) or chemotherapy, but these treatments are palliative and not curative.

13. What is the best treatment for prostate cancer?
This is highly controversial. Patients must weigh factors such as age, overall health, grade and stage of the disease, and risk of side effects versus complications from the various treatment options.